Depression and anxiety are like a pair of warring siblings. Both are disruptive and trying. They don’t want each other’s company, but are stuck together by virtue of the same parentage. Depression, after all, is often a product of rumination, the grating mental do-overs of ugly past events, usually with no solution in sight. Anxiety is the brainchild of too much forecasting of doom. Both seem to emerge from the sort of person who is stuck so securely in his mental time machine that he has no idea the roses are even there. Forget about stopping to smell them.

Courtesy of Luiz Fernando/Sonia Maria via Flickr.

Psychologists tend to link the depressed and the anxious by personality. Both groups share the trait of “negative emotionality,” the propensity to harbor bad feelings such as anger and anxiety. (In contrast to those with depression, though, those with textbook anxiety spike their dourness with a dollop of wellbeing, energy, closeness to others, and the like.) And of course, the two temperaments feed each other. If your future is so terrible, what’s not to be depressed about? Conversely, if you rake over the past enough, you’ll undoubtedly unearth a goof that is sure to destroy your prospects. For all these reasons, not to mention shared genetic risk factors, lots of people who are depressed are also anxious—and vice versa.

Yet these practically conjoined twins of psychological distress have long been separated in psychiatrists’ diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in its fourth incarnation. A depressed person is someone who feels overwhelmingly sad and worthless, the DSM says, and who can no longer enjoy activities they used to like. They may also have thoughts of death or suicide. Generalized anxiety disorder (GAD)—to pick one of the many certified forms of fretting—involves excessive, and at least somewhat debilitating, anxiety and worry about more than one part of your life that you experience on most days for six months or more.

But what about all those ruminators who can’t help forecasting future doom—and yet don’t qualify as officially depressed or pathologically anxious? Currently, as of the DSM-IV, these folks remain in a kind of diagnostic limbo. Their pending label, “mixed anxiety-depressive disorder” is in the book’s appendix, a place for proposed ailments in need of further study. Accumulating data suggest that these people are numerous. In the United Kingdom, national surveys suggest that 8.8 percent of the population would qualify for mixed anxiety and depression as defined by the World Health Organization’s compendium of diseases—the International Statistical Classification of Diseases and Related Health Problems (ICD-10). By comparison, fewer people—only 7.7 percent—satisfied diagnostic criteria for major depression, GAD or a combination.

Many of the 8.8 percent are more than moderately miserable. Studies show that the impact of this cocktail of sadness and worry on quality of life is similar to that for anxiety disorders: 12 percent of sufferers, for example, have reported suicide attempts and the disorder accounted for 20 percent of all disability days in the United Kingdom. So these folks do seem to need help.

Woody Allen escapes a “gorilla,” in the 1969 movie “Take the Money and Run.” Courtesy of John McNab via Flickr.

As a result of such findings, the framers of the DSM-5 originally proposed to move “mixed anxiety/depression” (with its slightly altered name) up to an official diagnosis, meaning insurance would reimburse you for treatment (which, drug-wise, is likely to be Prozac and its ilk). The proposed criteria for the new disorder included having three or four of the symptoms of major depression along with anxious distress. The latter required having two or more of the following issues: feeling nervous & anxious, inability to control worrying, having difficulty relaxing, being so restless it is hard to keep still, and fearing that something awful might happen. These problems must have plagued you for at least two weeks and must have caused “marked distress or significant impairment.” “Mood and anxiety disorders blur together,” says Scott Lilienfeld, a psychologist at Emory University. “This was an admission that they can’t be separated in any clean, neat way.”

And in this respect, the mixed disorder makes a great deal of sense. And yet as of last Thursday, the DSM-5’s framers seemed to take it all back. They reversed their initial push to promote this ailment to the body of the diagnostic bible. The criteria for mixed anxiety/depression were a bit vague and elastic, critics contended. The naysayers fretted that scads of mild chronic worriers—the Woody Allens of the world—would fall into it, their hypochondria ironically legitimized. The proliferation of false positives is a problem with the new DSM in general, some argue. “They are going to be diagnosing almost everybody,” Lilienfeld quips. Taking back the proposed mixed anxiety/depression diagnosis was one attempt to cut back on the number of newly mentally ill.

Of course, these critics could have been among the masses eligible for the proposed-now-nixed label, worriers that they are. But let’s give them some credit. Maybe they think they’re fine. And maybe they are.

The Joy of Quiet

By PICO IYER

Published in NY Times: December 29, 2011

We can resolve the inner weaknesses that make loneliness so painful.

More people are living alone than ever. In America, forty percent or more of all households contain a single occupant. Many people happily live alone—but others are tormented by the wail of the Lonesome Blues. That oldie can echo in our ears even when we’re surrounded by friends and family.

Loneliness is a common brand of human suffering. Many believe that loneliness is an inescapable fact of human existence, a curse we’re fated to endure from birth to death. The novelist Thomas Wolfe spoke to this idea: “The whole conviction of my life now rests upon the belief that loneliness, far from being a rare and curious phenomenon, is the central and inevitable fact of human existence.”

Wolfe was famous and admired during his lifetime, which apparently offered little solace or good company for his loneliness. Even “super-famous” Albert Einstein succumbed to the misery. “It is strange to be known so universally and yet to be so lonely,” he candidly commented. Being a rich celebrity doesn’t appear to help: “Hollywood is loneliness beside the swimming pool,” observed the actress Liv Ullmann.

Loneliness appears to have infiltrated if not occupied human nature. Impervious to the exhilarations of fame, wealth, and power, it produces assorted misery, ill health, and increased risk of heart disease. Maybe we can’t exterminate it, but we can see and understand the emotional weaknesses that make loneliness more painful than it would otherwise be. Being human is challenging enough. We don’t have to endure unnecessary suffering.

Most people who suffer with chronic loneliness are entangled in unresolved emotional attachments. Unwittingly, they chose to recycle unresolved emotions from their past. Usually these are associated with feeling unloved, rejected, betrayed, and abandoned.

Although it defies common sense, we go looking for old hurts that are unresolved from our past. We do not do this in order to resolve the hurts. Instead, we do it to relive the hurts. Whatever is unresolved in our psyche produces inner conflict that has a life of its own. The conflict can persist—and often get worse—until the day we die. The conflict behind loneliness is often our wish to feel loved and connected to life versus our unconscious willingness to go on feeling the old familiar abandonment and sense of being unloved.

We can be helpless to stop the suffering and self-defeat produced by the conflict when we don’t clearly enough see the nature of the conflict. Instinctively, we deny the existence of the conflict. Unconsciously, we offer up our loneliness as “proof” that we’re not colluding in our own suffering. Our unconscious defense maintains: “Are you nuts! I don’t want to feel unloved! I’m not clinging to old hurts! Can’t you see, in my loneliness, how desperately I want love and connection in my life!”

Who would have thought that loneliness can be part of a psychological defense? The loneliness defends us from the inner truth we hate to acknowledge because that truth is so amazing and humbling. In other words, we produce loneliness in order to cover up our willingness to experience again and again what’s unresolved in our psyche. The defense is offered up to our superego, the hidden master of our personality, which protests against our indulgence in our suffering. Here’s another rendition of the defense: “How can you suggest that I’m secretly invested in feeling unloved and abandoned! My loneliness proves how much I want to be loved. Look how much I suffer from the feeling of not being loved! Look at how much I hate being alone! Surely that proves that I’m not still clinging to the opposite feeling.”

The individual can make this defense more convincing by feeling more intensely the pain of loneliness. As with most of our psychological defenses, we often have to increase the level of suffering and self-defeat in order for the defense to continue over time to be effective (in the sense of deluding us). This produces (when loneliness or some other symptom such as anger is used as a defense) a stubborn determination to hold on to the misery of it.

Other factors can be at play on the field of loneliness. We can be fearful of not being accepted by others and fearful of being a disappointment to them. This means we’re emotionally attached to feelings of not having value and not being worthy. In a sense, we’re abandoning our own self by not believing in our self. “It’s so lonely when you don’t even know yourself,” an observer once noted. It’s more to the point to say, “It’s so lonely because you don’t know yourself.”

A harsh superego or inner critic, one that mocks and harasses us at the slightest provocation, can also create more feelings of isolation and loneliness. So can our inner passivity, which can paralyze us in a helpless conviction that there’s no escape from loneliness.

A remedy was proposed by Hermann Hesse, the Nobel Laureate who wrote Siddartha, a novel about the spiritual journey of an Indian man at the time of Buddha. Hesse said, “We must become so alone, so utterly alone, that we withdraw into our innermost self. It is a way of bitter suffering. But then our solitude is overcome, we are no longer alone, for we find that our innermost self is the spirit, that it is God, the indivisible. And suddenly we find ourselves in the midst of the world, yet undisturbed by its multiplicity, for our innermost soul we know ourselves to be one with all being.”

Key words in this passage are, “But then our solitude is overcome . . .“ The pain of our solitude is overcome when we’re sincerely interested in escaping this suffering and have the insight to do so. It helps to stay conscious of our resistance to letting go of suffering.

Once we see and begin to undo our attachments to feeling passive, rejected, unloved, and abandoned, we do, as Hesse said, connect with our innermost self and the whole of existence. Loneliness no longer fits across our shoulders. It falls by the wayside, a worn-out cloak that fades in the distance along with the wail of the Lonesome Blues.

Plenty of folks have considered the usual suspects in the sapping of sexual desire. A recent study of young women shows the most common factor in females is stress and fatigue, followed by poor self-image and then sexual difficulties such as the inability to reach orgasm. But a lack of desire can stem from conceptual problems involving the way you view sexual experiences, says Syracuse University neuroscientist Stephanie Ortigue. “Desire is more than an emotion,” says Ortigue. “It involves brain areas involved in thinking intellectual things. That is why it’s so personal, so subjective, and so common.”

And although endocrine, genetic and psychological factors can all contribute to desire, or the lack of it, Ortigue’s perspective comes largely from looking at brain circuits.

Several years ago, Ortigue’s team and two others sketched a network in the brain that is always activated when we experience sexual desire. The three research teams independently landed on the same brain regions. These included areas governing emotion, motivation, body image—and, notably, memories associated with life experiences. Memories can affect desire in subtle, subconscious ways. For example, if a person has a feature or personality that reminds you of something positive in your past, a subconscious association between that person and pleasant reveries may trigger desire, Ortigue says. In this way, desire emerges from a collaboration of emotional, motivational and intellectual parts of the brain, she says.

Ortigue and her team recently took a look at these brain regions in 13 women between 26 and 47 who qualified as having hypoactive sexual desire disorder. These women either had no feelings of sexual interest or those feelings had plummeted to a low level of late; many had no sexual thoughts or fantasies. They lacked any impulse to even try to become aroused. And they said the absence of these feelings and thoughts distressed them.

The researchers asked these women—as well as 15 women with no lack of desire–to look at both pictures of male models and nonerotic photos while their brains were being scanned. As expected, the women who lacked desire showed abnormally low activity in the brain network previously linked with that feeling. More surprising, however, was that these same women also showedmore activity in prefrontal brain regions involved in inhibition of action, attention to and judgment of the self, and interpreting the actions of other people. That is, that proverbial headache probably has its roots in this decision-making, self-control, theory-of-mind part of the brain.

The increased activity there suggests that people with depleted desire have two problems. One is that they are spending time trying to interpret the intentions of the other person—and probably coming to incorrect conclusions, says Ortigue. The second is that, they are monitoring or evaluating their own responses to erotic stimuli. They are not “living in the moment,” Ortigue says. Such analysis can interfere with the erotic experience, perhaps in the same way that explaining a joke can sap it of its humor.

The work dovetails with decades old studies by William H. Masters and Virginia E. Johnson, who coined a behavior called “spectatoring” they found common among people with sexual disorders. In spectatoring individuals become spectators of themselves during intimate encounters, viewing themselves from above and judging the situation.

“People really suffer from this,” says Ortigue, referring to hypoactive sexual desire. And knowing that the cause is less chemical in nature than psychological and intellectual may offer hope. Instead of fiddling with hormones, says Ortigue, teach people to stop judging themselves and others so much.